PRACTITIONERS
The “Physicians Act” of 1543, also called the “Quacks Charter,” defended the right of cunning men and women to use herbs, roots, and waters to treat diseases, but throughout this period an effort was made to control, by licenses, all those who gave medical aid to others. From 1511, bishops had licensed practitioners who were not university graduates, including surgeons. After 1560 they also regulated the activities of midwives.
Barber-Surgeons
The Barber-Surgeons became the first recognized medical guild in England in 1540. The barbers had been incorporated in 1462 by a charter that allowed them to let blood, engage in minor surgery, pull teeth, cut hair, and shave. Thus, at a barbershop, a man could have his hair and beard washed and trimmed, his teeth cleaned (by scraping) or drawn, his nails pared, his ears picked or syringed, and his blood let. After 1600 the barbershop also sold tobacco. Surgeons wore long robes while barbers’ robes were short.
Apothecaries
Apothecaries, whose numbers increased dramatically after Henry VIII closed down all the monasteries, were affiliated with the Grocer’s guild, since both apothecaries and grocers dealt in medicinal herbs. Many apothecaries used a Turk’s head with a gilded pill on his extended tongue for a tradesman’s sign. Pills were made by mixing powdered herbs into a stiff paste with honey, rolling this on a board, and pinching off small pieces which were then rolled into shape with the palms. Most drugs were kept in stoneware jars, the mouths or spouts closed by a piece of parchment that was tied in place. Moist drugs were stored in glass or horn containers. Dry roots were hung from the ceiling. In 1617 the Apothecaries’ Guild was chartered and began to use Cobham House in Blackfriars as a school for teaching physic.
Physicians
The best trained physicians spent seven years in England obtaining a master of arts, then acquired the M.D. degree at a foreign university, which they then “incorporated” at Cambridge or Oxford. Montpellier was the greatest medical center in Europe early in the sixteenth century. Bologna, Padua, Pavia, and Pisa all offered lectures in both medicine and anatomy. In the sixteenth and seventeenth century, “an anatomy” was a skeleton and the idea of studying the body by dissecting a corpse was regarded with great suspicion. In 1565, however, following Continental practice, the College of Physicians (which had been chartered in 1518) was granted up to four bodies of executed criminals a year in order to do dissections. Medical students did not often come in direct contact with patients, either. They read old books, attended lectures, and got their degree by spoken “disputation.” The College of Physicians licensed all physicians practicing within a seven-mile radius of London and examined any they considered either astrologically or medically unqualified.
A man’s humour (sanguine, choleric, phlegmatic, or melancholic) played an important role in treating his ailment. Physicians relied heavily on watercasting, the diagnosis of the balance of the humours by examination of the patient’s urine. The urine flask was used as a symbol of the physician’s profession. Administering purgatives and clysters and bleeding a patient were also common medical procedures. Each large English leech was able to suck three-eighths of an ounce of blood from a patient, and several were usually applied. There were specific bleeding points for some ailments, such as the outer side of the ankle for sciatica, even though the chronic pain would have been at the hip or thigh. The standard fee charged by a doctor was an angel, valued at ten shillings in Elizabethan times.
WOMEN IN MEDICINE
Female physicians had existed in previous centuries but were extremely rare by the sixteenth. Women barbers and surgeons had guild membership in some places. A woman surgeon was licensed in Norwich in 1568 and in 1572 York’s council supported Isabell Warwick’s case to continue doing surgery, but more common was the case of Ann Dell, a butcher’s wife of Shoreditch, who was charged with practicing surgery without a license in 1615.
Midwives
Midwives were the most numerous female practitioners. To obtain a license, a midwife had to satisfy church officials of her religious orthodoxy and good reputation. She took an oath, which in some cases covered the eventuality that she might have to perform emergency baptism. If the child was illegitimate, she was required to learn the father's name to save the parish the expense of caring for the child. She might also be employed by the parish to find witch marks. Most midwives made use of the birthing stool but obstetrical forceps (introduced in England in 1569 by a refugee doctor, William Chamberlen) were not. Payment varied according to the wealth of the household and could range from a piglet or chickens or a shilling to several pounds.
After 1610 the Barber-Surgeons licensed surgeons to assist at dangerous and difficult confinements, but in Caesarean sections, the woman always died.
Nurses
Nurses working in St. Bartholomew’s Hospital in 1551 included a matron and eleven “sisters,” the name a holdover from the days when nuns and novices did most of the nursing. The Savoy paid its matron £4 6s. 8d. a year. The women on her nursing staff were required to be unmarried and over the age of thirty-six (past the age when they might be inclined to seduce the patients). For 10d. a week they not only did the routine nursing work, they also did all the laundry, cleaning, and cooking.
Another type of nurse was anyone hired to care for plague victims who had no family or servants to look after them. One woman, who nursed a Dutch family in Sandwich in 1638, received 8s. a week for her trouble.
Searchers
A physician treated only the living. “Ancient matrons,” sworn to their office, were employed as searchers and called in to examine any dead person to determine the cause of death. If a death was suspicious, only then was a coroner called in. The parish records which specify what a person died of are thus based on the conclusions of an untrained observer who did no more than ask a few questions of the family.
HOSPITALS
All English hospitals were closed when the monasteries were dissolved, but a hospital at this time meant any refuge or shelter. In London, Bridewell sheltered vagabonds and beggars and was also a house of correction. Christ’s Hospital was for homeless children under the age of six. Only St. Bartholomew’s and St. Thomas’s actually took in the sick. The former closed in 1539 and was refounded in 1546. The latter closed in 1540 and reopened in 1551 with 260 beds. The Savoy Palace on the Strand, rebuilt as a hospital for the poor on Henry VII's orders, opened with 100 beds, each of which was equipped with three pairs of sheets, two blankets, a linen cover and a counterpane. By Elizabethan times, however, the Savoy had become little more than a sanctuary for criminals.
Bethlehem, better known as Bedlam, housed lunatics from 1403 onward. It was given to the city of London as a hospital “for distracted people” in 1546. In 1600, Bedlam housed some twenty patients supported by parishes and filled the rest of the space with private cases whose families were charged anywhere from 16-60p. a week. Inmates were classified as either “fools” (feeble-minded) or “madmen.”
THE PLAGUE
There were significant outbreaks of the plague in 1518, 1563, 1578, 1582, 1593, 1603, 1625, 1630, and 1636 and smaller epidemics in other years in specific areas such as Manchester, where 2,000 died of the plague in 1605. Usually outbreaks of plague started in early summer and were over by November. Bubonic plague, the most common form, had a fatality rate of 60-85%.
The first plague orders, in 1518, provided that infected households in London be marked by bundles of straw hung from the windows for forty days. Inmates were to carry a white stick if they went out into the streets. The book of plague orders issued by the Privy Council in 1578 was printed in 1583. By then houses were marked with a painted white cross. Still later a wooden cross, painted red, was nailed to the door, since it had proved too easy to wash away white paint. The first pesthouse (a hospital for people with an infectious disease) did not open in London until 1594.
The College of Physicians was scarcely more advanced than the local cunning woman when it came to preventing o
r curing the plague. Doctors often advised the use of a large onion, hollowed out and filled with fig, rue, and Venice treacle, as a preventive. Treacle, at least one variety, was made of sixty-four “drugs” including viper’s fat. Onions, peeled and left for ten days in the house, were also supposed to absorb all the infection in the air.
Other advice for avoiding infection included drinking four ounces of mummy (dead man’s flesh, dried) mixed with ten ounces of spirits of wine, drinking unicorn’s horn (swordfish blades) mixed with angelica root, wearing a bag of arsenic next to the skin, and burning old shoes to create purifying fumes.
ESTIMATES OF PLAGUE DEATHS IN LONDON
1563 20,000
1578 6,000
1582 7,000
1593 11,505-18,000+
1603 30,583-34,000
1625 35,428-50,000
1636 12,102
HEALING WATERS
Drinking or bathing in the waters of the warm spring at Buxton, especially as a cure for gout, became fashionable in Elizabethan times even though the accommodations there were poor. The therapeutic powers of the waters at Bath were lauded in print as early as 1562, but the old Roman baths there did not begin to achieve new popularity until after Queen Anne visited them in 1615. In 1646 there were complaints of rowdies throwing dogs, cats, and even pigs into the water while people were bathing. In 1606 the springs at Tonbridge Wells were found to have medicinal value, especially for splenetic distempers. Queen Henrietta Maria visited there. Knarlesborough was discovered, in 1620, to have waters which, while “vitroline” in smell and taste, did wonders for the stomach, bowels, liver, spleen, blood, veins, and nerves. The waters at Epsom may have been known as early as 1618 but the spring there tended to dry up. The twin springs at Leamington (one fresh and one salt water) and the spring at Newnham Regis were also in use in the early seventeenth century. In Wales, there was a healing well at Holywell in Flintshire.
AILMENTS
Although plague was the most memorable of the killer diseases and as such has been much studied, a man could die as easily from a cut, a bit of spoiled meat, or the cure mandated by his doctor. Chronic ill-health was normal at all levels of society once middle age was reached. Some of the most common ailments included bronchitis, gout, griping in the guts (gastric upsets), jaundice, kytes (chilblains), lice, rheumatic disorders, runny noses, shingles, sore eyes, sores, and worms.
ague: Various intermittent fevers (agues) were probably forms of malaria, which had been endemic in Europe for centuries. The cure (Peruvian Bark) was brought to Spain in 1639 but was not available to the general public. Symptoms of typhoid and of pneumonia may also have been mistaken for malaria. Blackwater fever and Lurden fever were two other names for the condition. The traditional cure in the Fenland was “the stuff,” opium poppy juice coagulated into pellets. Spider’s web was also recommended as a cure.
apoplexy: “A cold humour which stops the brain” (Andrew Boorde, Brevyary of Helthe, 1547), this condition was treated by blowing white hellebore, pepper, and “castery” into the nostrils.
asthma: Supposedly cured by wine in which woodlice had been steeped.
bleach: A skin disease that caused a whitening of the skin, bleach was sometimes mistaken for leprosy.
broken limbs: Oil of swallows (made with twenty-one herbs, neat’s-foot oil, cloves, wax, butter, and twenty live swallows all beaten together) was rubbed on a break after it was set. In 1610, when the earl of Northumberland broke his leg, leaden plates tied on with ribbon were used to set it right. The large, hollow-crowned root of comfrey was used as a bone-setter. The pulp was drawn through a linen cloth, then packed around the straightened bone as it lay in a wooden trough.
chaudepisse (gonorrhea): Believed to arise as a side effect of bladder stones, this venereal disease acquired the name clap during the late sixteenth century.
chincough: Whooping cough, known as “the kink” in Scotland.
consumption (tuberculosis): An infection spread most easily in close quarters such as small, smoky houses. Tuberculosis carried off large numbers of young women between the ages of fourteen and twenty. Those who were malnourished were least resistant to the infection. Modern researchers think tuberculosis, undiagnosed at the time, was the probable cause of death of Henry VIII's brother, Arthur, their father, Henry VII, and Henry VIII's illegitimate son, Henry Fitzroy, duke of Richmond. His other son, Edward VI, definitely died of acute pulmonary tuberculosis. Restoratives and cordials were prescribed, including those made of stewed pig, cock in jelly, and raw eggs. One drink said to cure consumption was made by only very slightly roasting half a leg of mutton, a piece of veal, and a capon and squeezing all their juices together with a dash of the juice of an orange.
dropsy: Spoken of as a disease caused by superfluous cold and moist humours, this term was used for some of the symptoms of scurvy and to describe ascites, the accumulation of free fluid in the peritoneal cavity because of colonic cancer or liver failure. As a preventive, blood was let on September 17.
English disease (rickets): Daniel Whistler (1619-1684) got his medical degree at Leyden in 1645 for his treatise on rickets, then known on the Continent as “the English disease” because the first recorded case of death by rickets seems to have been in England in 1634. James I may have suffered from rickets as a child. It is caused by lack of vitamin D in the diet.
falling sickness (epilepsy): Cured by drinking spring water at night from the skull of “one who has been slain.” Also useful were cramp-rings, rings hallowed by the monarch on Good Friday. When worn, these rings were also believed to ward off convulsions, rheumatism, and muscular spasms. The last blessing of cramp-rings was done by Mary I. Migraine or “megryn” was believed to be closely related to epilepsy.
flux: Probably dysentery and also called scouring and bloody flux and the Lask. Outbreaks often followed famine.
French pox: Early in the sixteenth century, syphilis was at its most virulent in Europe and it reached epidemic proportions in England in 1506 and 1546. The name syphilis came into use only after 1530, derived from the name of a character in a poem by Girolamo Fracastoro. It was generally referred to in England as the French pox or Great Pox. Early warning signs were the appearance of small lesions followed by a rash. Later manifestations were loss or thinning of hair and a distinctive stench that included bad breath. The favored treatment was the application of a mercurial ointment, although mercury was also administered orally and by fumigation. One salve contained “oldbane, oil of roses, quicksilver, bitterage of gold, and turpentine.” Turpentine was also popular as a dressing for wounds and serious cuts. As a preventive measure against French pox, men were advised to wash the genitals in vinegar or white wine and engage in “hard pissing” after sex. Women did the same—to avoid getting pregnant. Superior brothels provided separate chamber pots for the whore and her customer.
gaol fever (typhus): Common after the Wars of the Roses, some 300 people died at the “Black Assizes” at Oxford in 1577. Other outbreaks occurred at assizes at Cambridge in 1522, Exeter in 1586, and Lincoln in 1590, carrying off judges and jurors as well as prisoners. The fatality rate was about 50%.
green sickness (chlorosis): Anemia from lack of iron, this was common in young women.
heart disease: Nuts, milk, cheese, meat, and fruits were known to be “evil for this.”
immoderate pissing (diabetes): Treated with a purge and by forcing the patient to drink cold water until he vomited. Also recommended: eating four eggs prepared with powdered red nettle and sugar every morning.
impostumes: This could include any kind of abscess.
infertility: An infertile woman was advised to swallow an elixir of mare’s milk, rabbit’s blood, and sheep’s urine.
insomnia: For insomnia, Andrew Boorde (1490-1549) advised eating lettuce seeds, white poppy seeds, or mandragora seeds. Laying a mixture of one ounce of oil of violets, one-half ounce of opium, and woman’s milk on the temples with a fine linen cloth was also supposed to cure insomni
a.
inward burning distaste: Possibly a stomach or duodenal ulcer.
jawfallen: This was the Tudor name for tetanus.
King’s evil (scrofula): This disease was really tuberculosis of the soft tissues, generally the lymph nodes in the neck. Supposed to be cured by the royal touch, the form for this ceremony was included in the Book of Common Prayer until the reign of George 1.
leprosy: This disease had almost died out in England by Tudor times, but the term was also loosely used for skin conditions resulting from lupus, cancer, scabies (“the Scotch disease”), pellagra, and scurvy.
measles: Epidemic in 1517, this was dangerous because it often led to pneumonia. The term was also used for any condition in which the skin had spots or pustules.
mother: Disturbances of the mother (uterus) were thought to cause hysteria and could be fatal if swelling caused respiratory difficulty and suffocation. “Heaving of lights” (lungs) was sometimes listed as cause of death.
new ague: First seen in 1557, this was probably a form of influenza. The word influenza was not in use until the eighteenth century. See also: sweating sickness.
planet, planetstruck, moonstruck: Any sudden attack of illness, including stroke, catalepsy, paralytic seizure, and sunstroke, resulted in a diagnosis of “struck with a planet” or “taken in a planet” because the victim was supposed to have come under the hostile influence of a heavenly body.
The Writer's Guide to Everyday Life in Renaissance England Page 9